Few Vets Choose to Opt Out of VA Care

A much-heralded program aimed at speeding up access to medical treatment by allowing some patients to obtain care outside the Department of Veterans Affairs system has gotten off to a slow start.

In the San Diego region, only about 5 percent of the qualifying veterans have used the Choice Card option since it became available in November.

The national trend is even more anemic: Just three-tenths of 1 percent of eligible vets have made non-VA appointments through the program, according to information presented during a Feb. 11 congressional budget hearing.

Some of the barriers to higher usage include an agency standard on geographic distance that critics said is unreasonable, as well as certain patients traditional preference to see doctors within the VA network combined with fears of getting lost in bureaucracy.

Another key reason: Currently, the average wait time to see a non-VA specialist 40 days is roughly the same as within the system.

Veterans tend to prefer VA appointments. Theyre finding that maybe they cant be seen any faster than in the VA so theyre opting to keep their VA appointments, said Ray Deal, an assistant administrative chief at the San Diego VA Healthcare System.

Authorized by Congress in August, the Choice Card program created a referral system for veterans facing waits of longer than 30 days for a medical appointment or those who live more than 40 miles away from the nearest VA health facility. The option was one of several changes spurred by a scandal over long wait times for medical appointments in the VA network.

During the Feb. 11 hearing, VA Secretary Robert McDonald asked for flexibility in spending the $10 billion that Congress appropriated last year to pay for Choice Card services.

The request is facing opposition from Rep. Jeff Miller, R-Fla., chairman of the House Veterans Affairs Committee who has said he will not support using the money to bolster other parts of the VA budget.

Cards for the program began arriving in veterans mailboxes on Nov. 5, VA officials said.

As of Tuesday, 207 of the 3,943 qualifying vets in greater San Diego have scheduled appointments with non-VA health providers. Deal said hundreds more are in the process of doing so.

Those eligible for the Choice Card program can keep their VA appointments even if they schedule a visit to an outside physician.

Everybodys got their Choice Card, but I would say 99-plus percent of people are happy with the care theyre getting at the VA clinics across the county, said Stephen Arends, co-chair of the One VA San Diego community board that advises the local VA health system on veterans needs.

Last year in the San Diego region, VA records show that more than 99 percent of existing patients were seen within 14 days of their request for a primary-care appointment, and 98 percent got specialist care within that time frame.

The vast majority of those approved to receive private care in San Diego under the Choice Card program cannot be seen by VA doctors within 30 days. Referrals tend to be for physical therapy, mental health treatment and pain management.

One reason the average appointment wait time for a non-VA specialist is also long is because theres an overall shortage of mental-health specialists in the region for the VA and in the general population, Deal said.

In its 2014 appropriation, Congress also provided $5 billion to hire more health professionals to work directly for the VA. Deal said VA officials in San Diego are working to increase the number of mental-health counselors in their network.

The programs rollout, Deal added, has seen some bumpy spots. In several cases, as has been reported nationwide, veterans are finding that they live 40 miles away from the nearest VA clinic in terms of road miles but not 40 miles away as the crow flies as required by VA rules.

These veterans are having their requests for private appointments denied, though Deal said his office is able to appeal those decisions in some cases, especially if they must navigate around significant geographic features such as bodies of water or mountains.

There have also been some kinks to work out in scheduling systems and in communications between the VA and TriWest Healthcare Alliance, the private company that contracts directly with private doctors in 28 states to provide care for qualifying veterans.

David McIntyre, chief executive of TriWest, said Tuesday that his company has built a network of 3,800 physicians in the San Diego region, including 450 psychologists and 92 psychiatrists. The network is also used by the VA to provide services, including labor and delivery and radiation oncology, that are not offered directly within its system.

In 2014, VA San Diego spent $49.3 million on care outside its system in San Diego County, a number that included 16,011 referrals.

McIntyre said the Choice Card system was set up soon after Congress created the program last year. He said that required hiring 850 people to staff call-in service phone lines. He said getting those workers fully trained has taken time, as has nailing down the complex movement of scheduling data between VA and TriWest computer systems.

Weve identified the gaps that exist, weve prioritized them and were working to get them eliminated, McIntyre said.




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